Driving and Alzheimer’s

According to a Scandinavian study published in the Washington Post, about half of older drivers killed in traffic crashes have signs of Alzheimer’s disease. These statistics suggest that older drivers involved in accidents should be tested for cognitive performance such as thinking and judgment. Additionally, family members and doctors of individuals with Alzheimer’s should watch for symptoms of impaired judgment or coordination that can lead to vehicular accidents and/or fatalities.

Private cars account for over 90 percent of trips made by seniors,” said Dr. David Carr, a geriatrician and a professor at Washington University in St. Louis, when he spoke at the Institute for Dementia Research and Prevention Forum last October. “While it’s often imperative for the safety of the driver and others on the road, losing the ability to drive is one of the biggest blows to an elderly person’s independence.”

So, how do we take the keys away from Mom or Dad when they are suffering from Alzheimer’s and/or Dementia? As Dr. Carr inferred, the ability to drive is often the last bit of independence and symbol of competence that an individual has, so taking those keys away can be a daunting and formidable task.

There are generally three requirements to be an able driver: vision, cognition and motor ability. These characteristics often decline with age, and all contribute to the safety of driving.

If you’re loved one continues to drive, pay attention to some warning signs for unsafe behavior:

1) Does he/she have difficulty navigating to familiar places, changing lanes or making turns?

2) Does he/she confuse the brake and accelerator pedals?

3) Does he/she have difficulty reading traffic signals?

4) Does your loved one make slow decisions?

5) Do they drive at an inappropriate speed or hit curbs while driving?

6) Does he/she become angry or confused while driving?

If you answered yes to any of these questions, these are indications that it is time to have your loved one stop getting out on the road. Easier said than done.

It helps to see the physician and get a note from in writing to be a useful reminder for him/her to stop driving. It is also a good idea to keep car keys out of sight and if possible, remove the car out of the driveway so the individual is not reminded of it all day. Often, family members remove a battery cable or have a mechanic install a “kill switch” that must be engaged before the car will start. Some families get creative and tell their loved one that the insurance has expired and the car can’t be driven.

Or, the individual can undergo a Driving Assessment and from that authority, with results in hand, be willing to relinquish the keys. At the Baton Rouge Rehab Hospital, for instance, an Occupational Therapist can perform a clinical evaluation to determine the safety of driving. A cognitive assessment tool is given as well as a Road Evaluation and recommendations will be made based on these results.

Focused concentration and quick reaction time declines with age and accelerates with Alzheimer’s. At first, the decision may be difficult to take those keys away and your loved one may mourn the loss of independence. However, you would not want to endure the consequences of that loved one being involved in a traffic accident. Take the keys no matter how much it hurts the both of you. 

-Dana Territo, Director of Services

Long Distance Caregiving – A visit home

A little bit of your heart breaks when you witness yet another milestone in your parent’s decline with Alzheimer’s disease. Such was the loss for me when I traveled to visit my mom in January earlier this year. Mom had a mild stroke in early January and spent a week in the hospital. The neurologist said she would breeze through this one as she had no lasting visible affects. It was time for me to visit though, knowing ay 89 her next stroke may rob her of much more or that the progression of the disease would move more quickly. Spending time with her and giving my sister as her primary caregiver a bit of a break was important and more pressing now even though I don’t like Buffalo in the winter. 

I arrived late at night so didn’t see Mom until morning. Her routine is to get dressed before she goes downstairs as the stairs are a challenge so once a day is enough. She constantly asked, “What am I supposed to be doing?” Her disorientation of purpose was obvious. She’s always been a “doer” and never wasted a minute. She always had a needle and thread or was crocheting or reading a good book. Now the sewing machine sits idle when there was barely a day she didn’t use it when my seven siblings and I were growing up. It was easy to give her something to do though, help me fold the laundry, or peel the apples for a pie (I made 6 while I was there), or let’s play solitaire. She could help pin a pattern for some doll clothes to be cut out for the great grandchildren and even cut a few out all the while just listening to me chatter to engage her in the conversation. She no longer does the puzzles in the daily paper, too difficult she says. So instead I did them but asked her for help with answers I knew she could provide.

I treasured the week I spent with her. My sister was able to run errands and visit with her grandchildren. I was able to install a new handrail to help mom steady herself on the stairs, hang new drapery hardware to replace the broken rod, and any other task my sister needed help with. We were able to get to Mass, Mom’s first since the stroke. I was so happy she could sit with the choir and sing with them. I could hear her voice among the others and it brought me such comfort. She used to sing to us as she rocked us to sleep and then with the grandchildren. Her voice will always be in my head. 

The milestone of decline that weighed heavy on my heart was that in the 7 days I was there Mom could not call me by name. She knew I was a daughter, one of six, she knew I belonged, yet there was this…absence. I longed for the sound of my name yet never heard it. Although not hearing was an obvious omission to me what really mattered was we spent 7 wonderful days together. I helped her get dressed, I played her favorite music, and I showed her pictures of a recent trip to Ireland. We laughed an reminisced looking at over 1200 old pictures I had converted from slides to digital photos. Pictures she hadn’t seen in over 26 years. Pictures of her holding her babies, all 8 of us, and it was there she knew all the names of the children. It was a time I will always treasure.


-Barbara Auten, Executive Director

I didn't know I needed...

Recently, I attended a TLC for Caregivers event at Ruffino’s. A TLC for Caregivers is an event sponsored by the Junior League of Baton Rouge with a goal of giving the caregiver and the individual with Alzheimer’s an opportunity to socialize in a safe and welcoming environment. At this event I spoke to a caregiver who has just begun to utilize resources and programs offered by Alzheimer’s Services. She stated, “I didn’t know I needed Charlie’s Place.” I starting thinking about statements made by caregivers beginning with, “I didn’t know I needed …” Many times while speaking with a caregiver about their loved one’s care, a caregiver puts up a road block when they say, “We are not ready for that yet.” My question is when will you be ready or how can you know when you need anything?
 

• The statements below are statements from a caregiver who is approaching a dangerous stress level:

1.  I don’t care about getting together with the neighbors anymore. 
2. What happens when he needs more care than I can provide? 
3. I just don’t care anymore. 
4. I can’t remember the last time I felt good.

•  Questions to ask yourself, so you may be aware of your stress level

1. At the end of the majority of days, have you felt like you couldn’t make it through another day? 
2. Is your health at risk or beginning to suffer because of your caregiving responsibilities? 
3. Have you lost privacy or the ability to organize and run your household? 
4. Is there frequent conflict between household members related to caregiving issues? 
5. When you get a break from caregiving, do you still feel overwhelmed and exhausted?

Be realistic when considering the stress from caring for a loved one with Alzheimer’s. An activity that may assist in evaluating yourself may simply be a list. For example, use the above list of statements as a check list, if you find yourself making these statements the majority of times then make a deal with yourself that at that time you will call Alzheimer’s Services for their opinion about the next step that can be taken. It is also a good idea to use “the buddy system.” The buddy system should involve someone you talk to on a regular basis about caregiving. A buddy that will be able to say, “I hear you saying those negative comments, maybe you should think about making some changes so you can rest.” My goal is that each caregiver be able to evaluate their stress level and change the statement, “I didn’t know I needed” to the statement, “I knew I needed help when …”

Alzheimer’s Services is dedicated to helping you give the best care to your loved one. We are available to simply listen to concerns, answer questions, educate, and find ways a caregiver can reduce stress involved in caregiving or absolutely anything else you may need to provide the best care to your loved one.

WHEN YOUR LOVED ONE CAN NO LONGER LIVE INDEPENDENTLY

As we age, we may need extra help at home or need to move to a place that provides care.  As a family member or caregiver, you may need to help your loved one in the decision process and during the transition.

How do you know when your loved one can no longer live on his or her own?

Sometimes an illness, injury, or changing health will determine when a person needs to make a change. The need for change may also happen gradually over time. Signs that may indicate the need for a change include:

• Having difficulty eating, dressing, bathing, or using the toilet
• Forgetting to take medications or taking too many
• Behaving in ways that could be hurtful to themselves or to others, such as forgetting to turn off appliances
• Wandering from home or other signs of memory loss.

How do you talk about making a change?

Accepting change can be hard. Try being open and honest about what you see.

• Clearly state why you think independent living is no longer a good idea
• Listen to the person’s concerns; Reassure him or her you will do what you can to address those concerns
• Include your loved one in making the decision about where to live, if possible

Where should your loved one live?

When a person can no longer live alone, help him or her decide what type of living situation is best. Some options include:

• Staying at home with additional assistance
• Moving in with family or friends
• Assisted living communities
• Residential card facilities
• Skilled nursing facilities

What if your loved one resists making a change?

• Give the person time to get used to the idea
• Encourage the person to talk about how he or she feels
• Listen to concerns.  He or she may be worried about not liking the new place, about finances or about what will happen to the family home and belongings
• Provide clear, honest answers
• Ask for help from friends, family, a doctor or another respected person
• Ask the person to agree to a trial period

What can you do to help make it a positive move?

• After a move, ask friends and family to visit often, call, or send cards and letters
• Reassure the person; talk about the positive reasons for the move, such as security, comfort, companionship or professional care
• Allow the person time to adjust

What is Good Time Management?

It is simply three things. Working Smarter. Using Time Effectively. Coming Out On Top. Great time management means being effective as well as efficient. 

People don’t plan to fail, they fail to plan. 

Avoid being in the group of 90% that only gets 10% done. Be in the 10% that gets 90% done.   How do we do this? First let’s discuss some common time management “slip ups.”  Once we discover the slip ups, I’ll show you how to fix them.

1.) Failing to Keep a To Do List. Do you ever stop and tell yourself, “I know I’m forgetting something! What is it!!!?” To Do lists help you prioritize the tasks on your list. I like to use a white pad or notebook. I write the date in the upper right hand corner. I will start with #1 and list the name of the task. If that task entails a lot, I will then add A. B. C. so that I thoroughly list each thing that has to be done. When I complete something off my To Do list, I use a yellow highlighter. That shows me, “this is done, move on to the next task.” I like to keep some of my To Do lists so that I can go back and reference them. Just simply file them in a folder. 

2.) Not Prioritizing. Sometimes, it's hard to know how to prioritize, especially when you're facing a mountain of seemingly-urgent tasks. However, it's essential to learn how to prioritize tasks effectively if you want to manage your time better. Using the Urgent/Important Formula is an excellent tool. 

• Important activities have an outcome that leads to the achievement of your goals.
• Urgent activities demand immediate attention, and are often associated with the achievement of someone else's goals. Urgent activities are usually the ones that we focus on because they demand attention and the consequences of not dealing with them are immediate. 

3.) Failing to Manage Distractions.  If you want to gain control of your day, and do your best work, it’s important to know how to minimize distractions and manage interruptions effectively. There are going to be distractions, whether it is a colleague that needs assistance, a Walk-In that seeks help for their loved one, phone calls, or emails.  

•  Email: While email is incredibly useful, it's also one of the biggest work distractions we face. Many of us could spend entire days simply reading and responding to emails. The days that you have a big project to work on, close your email entirely or adjust the visual settings that distract you. If you have heavy email traffic that demands constant action, you may want to schedule specific times to check and respond to emails. 
• Phone calls:  When a call comes in for you, if you are hands and arms deep in a project, ask your secretary to take a message or let her know you will call the person back in 10 minutes. Be sure to return that call in the time promised…by simply making a quick note on a Post-It. Then, you can happily go back to your area of concentration. 
• Visitors. To minimize people coming into your office, close your door. A closed door usually lets others know you need some quiet time to concentrate.   
• Disorganization: A disorganized desk or surroundings can be a distraction.  Learn to keep a desk that is orderly so this is not a distraction to you. 
• Tiredness: Getting a good night’s sleep is essential to a productive work day. 
• tay Hydrated: Not being hydrated can actually lower your blood pressure, causing you to feel tired and have foggy thinking. 
• Eating Healthy: A diet rich in fruits, vegetables, and whole grains is always beneficial.  Foods affect how we feel and perform.   

4.) Taking on Too Much. Are you a person who has a hard time saying “no” to people?  If so, you probably have too many projects and commitments on your plate. This can lead to poor performance, stress, and morale. To stop this, learn how the subtle art of saying yes to the person but no to the task. “Anne, I’d really love to help you with this project today, but the monthly newsletter is due in two days, so, I must focus on this today." This helps you be assertive while still maintaining good feelings within your team of co-workers.

5.) Procrastination. We know procrastination occurs when you put off tasks you should be focusing on now. We are all guilty of doing this. Find what it is that is causing you to procrastinate. Learn to break down your bigger projects into manageable steps so that it’s easy to see everything you need to get done. Instead of taking on one big project and feeling overwhelmed, devote a certain amount of time to it, then go to your other project. Doing this can stop feelings of overwhelm.

6.) Ineffectively Scheduling Tasks. We all have different rhythms (times of the day) when we feel more energetic and productive. You can make the best use of your time by scheduling your high value work during your peak time and low-energy work (like returning phone calls or emails) during your down time. 

7.) Not Taking Breaks. Never think that taking a break is “wasting time.” It is impossible for anyone to focus and produce high quality results without giving their minds time to rest and recharge. Breaks allow us valuable down time which enables us to think creatively and work effectively. Sitting or standing for long periods of time is not good for the body either. So, remember to take a five minute break every hour or two. Also, make time for lunch or snack breaks, whichever you are used to. You cannot drive a vehicle that has no fuel!

8.) Not Setting Goals. People with goals accomplish 80% more than those who don’t have them. Setting goals helps develop clarity. It’s an important step in creating a life that you love and want. Goals are like our dreams! In setting goals, you get what you want instead of settling for what just comes your way per se. 

Develop good time management skills, and you are sure to succeed!

HAPPY BIRTHDAY! Charlie’s Place is 5 Years Old!

Charlie’s Place provides individuals suffering from any dementia-related disorders with cognitive stimulation and social interaction. Charlie’s Place also provides respite for the caregiver. Respite is an interval of rest or relief. Even if family assists with the care of a loved one, the primary caregiver may still be seeking rest and relief. When you walk through the doors of Charlie’s Place, caregivers, as well as their loved ones, feel safe and secure. We hope to give caregivers the chance to have that relief and to absolutely clear their mind, if for only a moment, of all caregiver duties and to actually take a deep breath and regroup. We are all equal in Charlie’s Place because we are all touched by this disease. Some of us have the disease and the rest of us are caring for a loved one with the disease.

Sunday, December 2 was the Charlie’s Place 5-Year Reunion Celebration. The event was attended by many people from Charlie’s Place, past and present. We were not celebrating the disease but rather the life families can still have with the disease. When getting the diagnosis of dementia, an individual, the caregiver, and the rest of the family may feel like life is over. At Charlie’s Place we make the most of the life we all have in spite of the disease. We still dance, we still laugh, we still smile, we still enjoy.

Many people enjoyed the Charlie’s Place Reunion and we asked participants to share a little about their experience at Charlie’s Place.

“No place like Charlie’s Place”

“Helps clients and also caregivers greatly”

“I visited Charlie’s Place and was treated to a birthday party”

“My mom sure likes to visit with everyone and all the staff is so caring, thanks”

“God bless Charlie’s Place … Wonderful atmosphere, love and acceptance, a warm welcome always”

“Charlie’s Place is like home to me, I love it!”

“Charlie’s Place is a saving grace, a comfy space, lots of caring”

We greatly appreciate all the warm thoughts and wishes about this wonderful program. We, Alzheimer’s Services, are honored to serve the individuals and the families who are affected by Alzheimer’s.

Contact Sports and Dementia

Like so many Louisianans, I spend my Sundays going to church in the mornings and watching football in the afternoons. It is one of the great pastimes for my family and friends. Each week we are waiting with anticipation for our team’s next game. We are engulfed in the cheering and high-fiving when our team (Saints of course!) tackle, sack, and block the opponent team. It seems like the harder the hit is the more excited we get. Sometimes I catch myself cheering for those hard hits. With the excitement of it all, we often forget the actual impact those hard tackles can have on players especially when that hard tackle causes a serious injury like a concussion. 

A concussion is an injury to the brain or spinal cord due to jarring from a blow, fall, or the like. Professional, collegiate, and high school football players can sustain multiple concussions during their tenure playing the sport. The impact of multiple concussions can be injurious.  It can have an immediate effect on young players such as the case of former Bengal’s receiver Chris Henry whose autopsy revealed years of brain injuries before his fatal accident.  Long-term effects have been revealed in the case of Alex Karras who succumbed to dementia, and Jim McMahon who has been recently diagnosed with dementia. 

A preliminary study conducted by Dr. Christopher Randolph, clinical professor of neurology at Loyola University Medical Center in Chicago, affirms that 1 in 3 retired football players will develop some sort of cognitive impairment.  In a separate study conducted by Dr. Bennett Omalu, he demonstrates a link between multiple concussions problems of NFL players and depression and early-onset dementia. National Institute for Occupational Safety and Health in Cincinnati researches wrote in the journal Neurology that professional football players are much more likely to die from Alzheimer's disease, ALS (Lou Gehrig’s disease) and other conditions cause by brain-cell damage. These researchers discovered that professional football players:  had triple the risk of death caused by diseases that destroy or damage brain cells compared to other people, had four a times greater risk of dying from ALS or Alzheimer's disease, and had about the same risk of death from Parkinson's disease as the rest of the population. They found that speed-position footballers were over three times more likely to die from a neurodegenerative cause than non-speed position players. These studies are preliminary but offer an interesting perspective to impact of violence in some sports.  More information on these studies can be found at www.fitzsimmonsfirm.com, Christopher Randolph, PhD, et al. Characterization of Mild Cognitive Impairment in Retired NFL Players, and Neurology ® the Official Journal of Medical Journal of Neurology (AAN). 

More research is being conducted to determine whether there is a conclusive link between recurrent concussions and dementia in football and similar contact sports. As much as I enjoy football, I have become increasingly aware of the impact it can have on players. Safety comes first before entertainment. I would rather these players practice safety than forfeit their health.  This doesn’t just apply to adults but also to kids playing contact sports. Make sure they are wearing the proper helmets and equipment for the activity. Always seek treatment first if you think you may have a concussion and encourage others to do the same. Once a first concussion is diagnosed, don't return to the activity that caused it until the symptoms go away and a doctor has given the okay.  Be safe and encourage safety. Now let’s watch some football!